Having CAR T-cell therapy

Before being admitted to hospital for CAR T-cell therapy, you'll need to prepare. You can find more details on our Getting ready for CAR T-cell therapy page.

The therapy includes three key steps:

1. Collecting your T cells
2. Making your CAR T-cells
3. Infusion of the CAR T-cells

You can read more about each of these steps below.

Your hospital team will collect your T cells through a process called leukapheresis:

1. A nurse will put a needle and thin tube (cannula) into a vein in each arm, or they may use a central line in your chest or groin.
2. Blood will flow from one arm into a machine that separates your blood cells, called an apheresis machine.
3. This machine will remove your T cells from the rest of your blood.
4. The rest of your blood will return to your other arm.
5. The hospital sends the collected T cells to the laboratory to make your treatment.

This process usually takes several hours, and sometimes it may take two days to gather enough T cells. Bring something to keep you busy, like a book or tablet. For more ideas, check our Getting ready for CAR T-cell therapy page.

Remember, if you have a cannula in both arms, you might not be able to move them much. Using an e-reader could be easier than handling a book. Most people feel OK while their cells are collected, but you might feel a little tired during or after the procedure. Always let your healthcare team know if you feel uncomfortable or have any worries.

After collecting your T cells, the hospital will send them to a lab to create your treatment. You can learn more about this on our What is CAR T-cell Therapy? page.

In the laboratory:

1. Scientists will genetically modify the DNA of your T cells to make CAR T-cells.
2. They will grow the cells until there are enough for your treatment. This usually takes a few weeks.
3. When your CAR T-cells are ready, the laboratory staff will freeze them and send them back to the hospital.

Note: Sometimes, the lab might not be able to make the CAR T-cells successfully. If this happens, your doctor will discuss it with you and explain what the options are.

While you wait for your CAR T-cells to be made, you might have treatments to keep the blood cancer under control, called bridging treatment.

You will have chemotherapy about a week before receiving your CAR T-cells. This treatment is called lymphodepletion.

You can read more about bridging treatment and lymphodepletion on our Getting ready for CAR T-cell therapy page.

On infusion day, you'll receive your CAR T-cells at the hospital. The staff will thaw your CAR T-cells, and a trained nurse will give them to you through a thin tube in a vein. This process is similar to getting a blood transfusion and should take about 15-30 minutes.

Before the infusion, the nurse will give you medicine to help prevent any allergic reactions or fever.

After your infusion, you will stay in the hospital for about 10-14 days while you recover. After this, you may go home if:

• You have recovered from any side effects you’ve experienced.
• You live within a 1-2 hour drive from the hospital (depending on your hospital’s guidelines) in case you need further care.
• You have someone at home to care for you full-time.

If you don’t meet these conditions, you will stay in the hospital for at least 28 days after your infusion to make sure you are well enough to go home.

In the first 28 days after your infusion, be aware of some possible short-term side effects, including:

• cytokine release syndrome (CRS)
• immune effector cell-associated neurotoxicity syndrome (ICANS)
• tumour lysis syndrome (TLS)

Your hospital team will watch for these side effects while you are there. For more information about these and other side effects, as well as what to expect during your recovery, visit our CAR T-cell therapy recovery and side effects page.

This information was developed in partnership with Anthony Nolan.